Table 2.

Studies comparing a sedative against another sedative, placebo, or standard treatment for VCUG. Outcomes, results, and follow-up. (NSD: no significant difference; VCUG: voiding cystourethrogram; RNC: radionuclide cystography; VUR: vesicoureteric reflux; SD: standard deviation).

Authors; year; country	Sedation score outcome and results	Distress outcome(s) and results	Urological outcome(s) and results	Safety outcome(s) and adverse events
I. Akil, M. Ozkol, O. Y. Ikizoglu, M. Polat, O. Y. Tuncyurek, O. Taskin, H. Yuksel; 2005; Turkey [41]	Breitkopf and Buttner classification of emotional status [87], 1.87 (SD0.72) in midazolam versus 1.35 (SD0.49) in control (P = .01), duration of sedation is 68 min (midazolam), 28 min (chloral), P < .001	Frankl behaviour rating score [88] NSD; Spielberger's state anxiety inventory [41] NSD; Houpt behaviour scale [88] of 4.93 (SD1.12) in midazolam group versus control of 4.12 (SD 1.05) in chloral group, all NSD	Postvoid residual volume, VCUG grading, no difference found	None found, defined as drop in PaO2/Sats by 5%, systolic blood pressure drop of 15 mm Hg, drop in pulse to 60 bpm
J. S. Elder, R. Longenecker; 1995; USA [43]	None	Phone call at 48 h, recall, behavioural side effects; parental wishes, 97 out of 98 contacted, 56 children (60%), no recall of VCUG, 19 (21%) recalled parts, 10 remembered the procedure without negative experience, 9 recalled a negative experience, 12 out of 97 children had behavioural side effects reported after the study, 92 out of 97 (95%) parents of sedated children would request the use of midazolam again	Postvoid residual volume (Bis and Slovis method [89]), no residual volume in 74% of midazolam group and 72% of control group; NSD	Saturation decrease by 10%, systolic BP drop by 15 mm Hg, respective rate down to 8/min, HR down to 60/min, one child had a transient decrease in saturation requiring no intervention
D. W. Herd, K. A. McAnulty, N. A. Keene, D. E. Sommerville; 2006; New Zealand [45]	None	Independent observer Groningen distress rating scale [90]; nursing GDRS; heart rate; parent-child interaction, 61% of placebo group experienced serious or severe distress (GDRS of 3 or 4); 26% of midazolam group had the same distress; number needed for treatment was 2.9 (95%CI 1.9–5.5)	VUR grade; volume infused, no difference in volume infused (P = .8), no difference in VUR grading (P = .31), a priori power of 90%	Oxygen requirement (Sats <94%), two children in midazolam group had transient desaturations to less than 94% and were given oxygen
I. Keidan, R. Zaslansky, M. Weinberg, A. Ben-Shlush, J. M. Jacobson, A. Augarten, Y. Mor; 2005; Israel [47]	AVPU (alert, responds to voice, responds to pain, unresponsive)	FLACC (face, legs, activity, crying, consolability) score for pain [91]; anxiety score (observer scale of behavioural distress) [92]; no difference between midazolam and nitrous oxide, number of children requiring physical restraint is 10/24 in midazolam and 2/23 for N2O (P = .01)	Time to micturition 7.2 (SD2.5) min for midazolam and 15.3 (SD 17.3), P = .8	Oxygen saturation <93%, alteration in heart rate or BP by 15% from baseline, oversedation defined as “U” on the AVPU scale
P. A. Merguerian, S. T. Corbett, J. Cravero; 2006; USA [48]	Not reported	None	Void to completion; sedated children (55%) could void to completion compared to 89% nonsedated (P < .001)	Not reported
E. Stokland, S. Andréasson, B. Jacobsson, U. Jodal, B. Ljung; 2003; Sweden [52]	None	VAS from 0 mm to 100 mm (severe problems); nurse observation VAS NSD, parent VAS, administration of midazolam more uncomfortable (P < .001), catheter, and overall procedure more uncomfortable with placebo (P < .001); parent follow-up questionnaire at 12, 24, and 48 h of “reactions,” NSD	VUR grade; volume infused; ability to void; NSD	Not defined, none reported
J. L. Zier, K. A. Kvam, S. C. Kurachek, M. Finkelstein; 2007; USA [59]	None	Brief behavioural distress score (BBDS) for VCUG, median age of 44 (range of 11–100) nonsedated, 11 (range of 0–67) sedated (P < .001), patient self-reported Wong-Baker FACES pain rating scale, 6 after catheter in nonsedated, 0 in sedated (P < .001)	Time to bladder emptying; NSD	One patient in sedated group experienced nausea, no desaturations